Group align­ment

Rec­om­men­da­tions aim to re­duce provider bur­den

Modern Healthcare - - The Week In Healthcare - Rich Daly

Afederal ef­fort to re­duce the pa­tient­data re­port­ing bur­den on providers and align pub­lic and pri­vate qual­ity ef­forts has pro­duced its first rec­om­men­da­tions. How­ever, nei­ther pub­lic nor pri­vate in­sur­ers are re­quired to im­ple­ment the fi­nal prod­uct of the stream­lin­ing ef­fort.

The Mea­sures Ap­pli­ca­tion Part­ner­ship— a group of lead­ing pub­lic and pri­vate health­care or­ga­ni­za­tions—re­leased a draft strat­egy last week that aims to align the var­i­ous physi­cian per­for­mance mea­sures. The group, cre­ated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act and led by the Na­tional Qual­ity Fo­rum, also aims to align pub­lic and pri­vate ef­forts to re­duce health­care-ac­quired con­di­tions and read­mis­sions.

“There is mis­align­ment of mea­sures within the var­i­ous pro­grams that are col­lect­ing data for par­tic­u­lar pur­poses, and bet­ter align­ment will lead to less bur­den on the providers who are re­port­ing the in­for­ma­tion, as well as more co­her­ent in­for­ma­tion coming out of that mea­sure­ment,” said Dr. Tom Valuck, se­nior vice pres­i­dent for strate­gic part­ner­ships at the NQF.

Last year’s fed­eral health­care law re­quired the HHS sec­re­tary to con­sider us­ing only the group’s com­ments to se­lect and align the var­i­ous per­for­mance mea­sures for pub­lic re­port­ing and per­for­mance-based pay­ment pro­grams, such as the CMS’ Value-Based Pur­chas­ing Pro­gram and Physi­cian Qual­ity Re­port­ing Sys­tem. How­ever, the draft fed­eral qual­ity mea­sures is­sued so far fit the group’s draft rec­om­men­da­tions, Valuck said.

But even if fed­eral insurance pro­grams adopt the even­tual rec­om­men­da­tions, se­ri­ous doubts re­main over whether pri­vate in­sur­ers are even ca­pa­ble of fol­low­ing suit.

“Know­ing that Medi­care can iden­tify a par­tic­u­lar hos­pi­tal-ac­quired con­di­tion through its claims data doesn’t mean that ev­ery­one can,” said Nancy Foster, vice pres­i­dent for qual­ity and pa­tient-safety pol­icy at the Amer­i­can Hos­pi­tal As­so­ci­a­tion. “Know­ing that Medi­care can al­ter its pay­ment sys­tem in a par­tic­u­lar way doesn’t mean that ev­ery­one can.”

An ex­am­ple of pri­vate in­surer ob­sta­cles to fol­low­ing the same stan­dards as pub­lic in­sur­ers came in 2008 when Medi­care de­cided it would cut pay­ments for health­care ser­vices stem­ming from hos­pi­tal-ac­quired con­di­tions. When pri­vate in­sur­ers at­tempted to fol­low suit, some found their billing sys­tems could not iden­tify whether they were even fund­ing such ex­tra care.

De­spite those im­ple­men­ta­tion chal­lenges, Foster, who served on a MAP work group, said she is op­ti­mistic that the group will ul­ti­mately point the way to in­creased stan­dard­iza­tion.

“If we all know what the game plan is, then we can work to­ward achiev­ing it,” she said.

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